Sutor A H, Uhl M
Kinderklinik der Albert-Ludwigs-Universität Freiburg, Germany.
Semin Thromb Hemost. 1997;23(3):237-46. doi: 10.1055/s-2007-996096.
Thromboembolic disorders are frequent complications in pediatric patients and the incidence seems to rise. Adult guidelines for thromboembolism do not hold for children because there are many age-related features. Congenital prethrombotic disorders play a major role in the pediatric population and activated protein C (APC) resistance is also the most frequently encountered problem. Acquired risk factors in children are central venous line thrombosis with serious complications, cardiac diseases such as cardiomyopathies, prosthetic heart valves and aneurysms, renal vein thrombosis, and nephrotic syndrome. Renal vein thrombosis primarily affects newborns. Children with the antiphospholipid antibody syndrome also have thromboses although less frequent than adults, but systemic lupus erythematosus is associated with a high incidence. Acute lymphoblastic leukemia is frequently associated with thrombosis in children, especially when complicated by APC resistance. The greatest risk of thrombosis in children is during the neonatal period, and again congenital prethrombotic states and catheter placement play a major role. The clinical manifestations in children reflect the site of the thrombosis and extensive laboratory evaluations and advanced diagnostic procedures must be employed to diagnose the thrombotic events.
血栓栓塞性疾病是儿科患者常见的并发症，且发病率似乎呈上升趋势。成人血栓栓塞指南并不适用于儿童，因为存在许多与年龄相关的特征。先天性血栓前状态在儿科人群中起主要作用，活化蛋白C（APC）抵抗也是最常遇到的问题。儿童获得性危险因素包括伴有严重并发症的中心静脉置管血栓形成、心肌病、人工心脏瓣膜和动脉瘤等心脏疾病、肾静脉血栓形成以及肾病综合征。肾静脉血栓形成主要影响新生儿。抗磷脂抗体综合征患儿也会发生血栓形成，尽管比成人少见，但系统性红斑狼疮与之关联的发病率较高。急性淋巴细胞白血病在儿童中常与血栓形成相关，尤其是合并APC抵抗时。儿童血栓形成的最大风险期是新生儿期，先天性血栓前状态和导管置入再次起主要作用。儿童的临床表现反映了血栓形成的部位，必须采用广泛的实验室评估和先进的诊断程序来诊断血栓形成事件。
